Today, while there are effective drugs that reduce the risk of osteoporotic fracture, yet there are no broadly accepted criteria that can be used to estimate risks and decide who should receive treatment. One of the actual priorities of clinical research is to develop a set of simple and readily-available clinical data that can be used in routine clinical practice to identify patients at high risk of bone fracture, and to establish thresholds for therapeutic interventions. Such a tool would have high impact on healthcare policies. The main objective of the ESOSVAL-R is to develop a risk prediction scale of osteoporotic fracture in adult population using data from the Region of Valencia, Spain.

Objectives To analyse the effect of educational level on the progression from HIV seroconversion to highly active antiretroviral therapy (HAART) requirement, HAART initiation, AIDS and death from any cause at different periods of the HIV epidemic in Spain. Methods Open, prospective, multicentre cohort of HIV seroconverters set up in 1983. The risk of progression was calculated by the multiple decrements method. Effect of educational level was estimated by Fine and Gray model, adjusting for sex, HIV transmission category, age and method to estimate seroconversion. Calendar period was introduced as a variable that could change over time (2003). Results Up to 2009, 989 HIV seroconverters with information on educational level were identified. Some 52% and 48% had a low and a high educational level respectively. Persons with higher education had 32% lower risk of death (HR: 0.68; 95% CI 0.45 to 1.03). Regarding progression to AIDS, educational level had no effect in the pre-HAART era (HR: 1.47; 95% CI 0.91 to 2.38), but did show an effect in the period 1997–2003 (HR: 0.58; 95% CI 0.34 to 0.99), which was accentuated after 2004 (HR: 0.26; 95% CI 0.10 to 0.68). No difference was found in time to HAART requirement or initiation. Conclusions Results suggest that, despite similar access to HAART, persons with low educational level are at increased risk of HIV disease progression, highlighting the impact of social inequities on health. The availability of more effective treatments over time will strengthen the protective effect of higher education on the development of AIDS.

A study to evaluate the adherence to and appropriateness of anti-osteoporotic treatments in a cohort of men and women aged 50 and over participating in the ESOSVAL-R study.

In cohort or longitudinal studies, subjects are recruited some time after the beginning of the problem, as in HIV infection. The aim of this paper is to show several imputation techniques of the beginning of follow up and evaluate its use in the framework of a study of HIV progression. Three subcohorts of HIV+ subjects recruited in Valencia and Castellón CIPS up to 1996 are available. Seroconversion date was estimated for 244 Seroincidents, 887 seroprevalents with CD4 measurements and 337 without CD4 measurements. For seroincidents midpoint between last HIV- and first HIV+ visits was considered. For prevalent with CD4 serocon version date was imputed from 5 random samples of a progression model of infection to a CD4 level. For prevalent without CD4 seroconversion date was imputed from 5 random samples of HIV incidence density obtained from the other subcohorts. The imputation was repeated 500 times, assigning the seroconversion date as the median of imputations and obtaining confidence limits from 5 and 95 percentiles. Imputation validity was tested comparing time to AIDS and death for each one of the 3 groups. 443 and 405 deaths were observed among the 1468 subjects. Median of seroconversion was January 1993 for incidents, January 1991 for prevalents with CD4 and November 1988 for prevalents without CD4. The latest group showed a worse survival and AIDS free time compared to the other two cohorts. The imputation tools used showed their usefulness to reduce the survival bias in observational studies. Their generalization depends on the viability of incident cohorts, the availability of a progression marker or a origin on time.